Should Physicians Address Patients' Spiritual Needs?

Horlen, Cheryl; Malone, Robb; Bryant, Betsy; Dennis, Betty; Carey, Tim; Pignone, Mike; Rothman, Russell L.

doi:10.1001/jama.287.19.2502

Cited by 39 publications

(4 citation statements)

References 15 publications

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“…However, as the patient-physician relationship develops, we believe that it may be of value to both the patient and the caregivers for the physician to explore the patient's existential and spiritual concerns. For physicians to attain the selfconfidence to perform this function, however, requires a deeper understanding of the issues than can be provided by reading an article on practical guidelines" [8]. They recommend a "clinical pastoral education program" modified for clinicians so as to provide the medical professionals with the skills, language, and experience to provide good Spiritual Care.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

CTOIJ

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Human Being is a complex Being with not just physical, emotional and social needs but also Spiritual needs. Medical Professionals are trained to treat the physical and sometimes emotional and social aspect of a dis-ease but receive no formal training in addressing spiritual needs of a patient. This article is mini-review of the literature and an opinion on should medical professionals provide care to address spiritual pain.

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Section: Discussionmentioning

confidence: 99%

Untitled

2017

CTOIJ

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“…Despite the restrictions in place, there is substantial evidence indicating prescribers have continued to use metformin in patients with contraindications. [16][17][18][19][20][21][22][23] The Diabetes Audit and Research in Tayside Scotland/Medicines Monitoring Unit (DARTS/MEMO) investigators performed a retrospective cohort study evaluating patients with T2DM in the Tayside, Scotland, region from January 1993 to June 1995. 16 The investigators' purpose was to determine how many patients receiving metformin had a contraindication to the drug.…”

Section: Metformin Use In the Setting Of Contraindicationsmentioning

confidence: 99%

“…Although contraindications are present, the previously mentioned studies indicate prescribers have continued to use metformin even in these settings. [16][17][18][19][20][21][22][23] In order to evaluate the safety of metformin in those with a reduced renal function, several studies have been published assessing these concerns. 13,[24][25][26] Rachmani et al set out to evaluate the appropriateness of the contraindications to metformin therapy in a prospective randomized controlled trial.…”

Section: Safety In Reduced Renal Functionmentioning

confidence: 99%

Monitoring Patients on Metformin: Recent Changes and Rationales

Wooley

Kerr

2017

Journal of Pharmacy Technology

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Objective: The Food and Drug Administration recently updated metformin prescribing recommendations for patients with diabetes and renal disease. The American Diabetes Association as well as the American Association of Clinical Endocrinologists and American Clinical Endocrinologists also recommend periodic monitoring of vitamin B 12 levels for patients using metformin. A review of the literature was conducted to assess data to evaluate the recent updates to metformin usage and provide rationales for these recommendations. Data Sources: PubMed MESH terms "Diabetes Mellitus, Type 2" and "Renal Insufficiency, Chronic" and "Metformin" were searched with an English limitation from 1990 to May 2017. A MEDLINE search was conducted using the terms "metformin" and "renal disease" from 1990 to May 2017. A PubMed search was conducted using the MESH terms "vitamin b12 deficiency" and "metformin" from 1970 to May 2017. A MEDLINE search was conducted using terms "metformin" and "vitamin B12 deficiency" with an English limitation from 1970 to May 2017. Study Selection and Data Extraction: Retrospective and prospective clinical trials, meta-analyses, and systematic reviews were considered for inclusion. Citations from identified articles were also reviewed for inclusion. Data Synthesis: The incidence of metformin-associated lactic acidosis is minimal. Data indicate metformin-treated patients with an estimated glomerular filtration rate above 30 mL/min/1.73 m 2 have a reduction in mortality. Additionally, data suggest metformin may lead to vitamin B 12 deficiency. Conclusion: Data support recommendations for metformin use in patients with diabetes and renal insufficiency with an estimated glomerular filtration rate above 30 mL/min/1.73 m 2. Data also suggest that baseline and periodic testing of vitamin B 12 levels are warranted and supported by clinical guidelines due to the risk of vitamin B 12 deficiency in metformin-treated patients.

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“…However, it is extremely rare [ 9 ] for adverse reactions to be directly caused by placebos. There are two overlapping explanations for how this might occur.…”

Section: Introductionmentioning

confidence: 99%

Nocebo effects and participant information leaflets: evaluating information provided on adverse effects in UK clinical trials

Kirby

Shepherd

Howick

et al. 2020

Trials

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Background: Nocebo effects ('negative placebo' effects) experienced by clinical trial participants can arise from an underlying condition or through communication about side effects in the participant information leaflets (or elsewhere). Misattributing nocebo effects to the medicinal intervention can lead to participants experiencing harmful nocebo effects and may result in distortion of adverse effect reporting. However, little is known about how information on potential side effects is provided to trial participants. There is increasing concern that the way in which potential side effects in clinical trials are described to patients in participant information leaflets (PIL) can in itself cause harm by either increased anxiety, poor adherence or inducing the side effect itself. In this study, we aimed to explore these concerns and identify the way in which potential side effects from investigational medicinal products used in trials are presented in written information to potential participants. Methods: Trials were identified from the International Standard Randomised Controlled Trials Number (ISRCTN) clinical trial registry (a primary registry of the WHO International Clinical Trials Registry Platform (ICTRP)). Eligible studies were placebo-controlled clinical trials of investigational medicinal products (IMP) in adults conducted in the UK. We assessed readability using the Flesch Reading Ease scale, Gunning-Fog Index and Flesch-Kincaid Grade. Data extracted from the PILs were divided into 8 predefined qualitative themes for analysis in NVivo11. Results: Most of the patient information leaflets were ranked as 'fairly difficult to read' or 'difficult to read' according to the Flesch Reading Ease scale. All studies presented information about adverse events, whereas only a third presented information about intervention benefits. Where intervention or study benefits were presented, they were usually after adverse events (21/33, 64%). Discussion: Participant information leaflets scored poorly on ease of readability and had more content relating to adverse effects than any potential beneficial effects. The way in which adverse events were presented was heterogeneous in terms of their likelihood and severity and the amount and level of detail provided. By comparison, potential benefits from the intervention and/or study were described less often, by shorter text, and only after information about harms.

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Should Physicians Address Patients' Spiritual Needs?

Cited by 39 publications

References 15 publications

Untitled

Untitled

Monitoring Patients on Metformin: Recent Changes and Rationales

Nocebo effects and participant information leaflets: evaluating information provided on adverse effects in UK clinical trials

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